General Surgery Coding Alert

Plus: CMS reverses some venipuncture and catheter placement edits.

Your general surgeon may remove a patient's appendix during another laparoscopic or open abdominal surgery -- but don't expect payment for the appendectomy, thanks to new edit pairs in the latest Correct Coding Initiative (CCI) update.

CCI version 17.3, which takes effect Oct. 1, offers 1,380 new edit pairs and 835 terminated bundles, according to an analysis by Frank Cohen, MPA, MBB, principal and senior analyst with The Frank Cohen Group, LLC. Let us help you peer through the numbers to learn the CCI changes that will impact your general surgery practice.

Expand Appendectomy Billing Restrictions

Prior to CCI 17.3, CMS already bundled lap appendectomy (44970, Laparoscopy, surgical, appendectomy) as the column 2 (component) code to multiple procedures from the surgical laparoscopy CPT® sections for esophagus, stomach, bariatric surgery, intestines, rectum, liver, billiary tract, and abdomen. These edits all show a modifier indicator of "1," meaning that you can override the edit pairs when circumstances warrant.

Tip: To avoid improperly "double dipping" laparoscopic surgery claims, "Always check CCI edits before you bill multiple scopes," says Sundae Yomes, CPC, coder at HCA Physician Services in Las Vegas.

17.3 adds appendectomy bundles: Under CCI 17.3, you'll find 44970 bundled into most surgical codes -- open or laparoscopic -- involving the pelvic region. That includes bundles from splenectomy (38100-38120), to proctopexy (45400-45402), and beyond.

Likewise, CCI now bundles the surgical appendectomy codes 44950-44960 (Appendectomy ...) into many other pelvic surgeries. Although the open appendectomy edits are not as vast as those affecting laparoscopic appendectomies, you should get familiar with the bundles to avoid denials for your surgery practice.

Watch '0' modifier indicator: You can't unbundle the new appendectomy edits using a modifier (such as 59, Distinct procedural service) under any circumstances. CMS indicates the restriction by placing a "0" modifier indicator on the nearly 500 new appendectomy code pairs.

Loosen Venipuncture/Catheter Constraints

CCI 17.3 repeals approximately 80 long-standing edit pairs that restrict how you code venipuncture, venous and arterial catheter placement, and transfusion procedures.

You'll no longer have to deal with CCI restrictions that bundle many of the following codes with each other:

• Venous injection or catheter introduction procedures (36000-36015)
• Arterial injection or catheter introduction procedures (36100-36247)
• Venipuncture procedures (36400-36425)
• Transfusion procedures (36430-36460)
• Arterial puncture procedures (36600, 36640)
• Transcatheter infusion (37202).

Caution: Don't automatically change your coding habits and "unbundle" these services all the time. Even without the edit pairs, you'll need to ensure that your surgeon's documentation supports billing distinct procedures.

"The reason for this CCI change is unclear, but you should continue to follow coding conventions, such as routinely bundling arterial catheterization codes (36215-36247, Selective catheter placement, arterial system; ...) into most services that include an arterial approach," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle.

For more on CCI edits and to find which ones impact your practice, visit the CMS Web site at www.cms.gov/nationalcorrectcodinited/ncciep/list.asp.